To: Participating Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, School-based Linked Health Centers and Local Health Departments
Re: Preconception Risk Assessment
The Illinois Department of Healthcare and Family Services (HFS), in coordination with eQHealth Solutions, Illinois' Quality Improvement Organization, are working together to improve birth outcomes among low income Illinois women. Unaddressed, preexisting maternal health conditions that adversely impact subsequent births highlight the need for preconception care.
This notice serves as notification of HFS' implementation of a Preconception Risk Assessment and Clinical Guidance Tool beginning January 1, 2012.
HFS covered almost 54% of the state's births in CY2009, and of those, almost 60% were unintended. Additionally, 40% of the total births were non-normal (low birth weight, very low birth weight, fetal demise and other non-normal conditions), which accounts for 70% of the total birth costs. HFS recognizes there is great opportunity to strengthen advocacy, improve health, and establish pregnancy planning for women at risk of poor birth outcomes. It is important to note that the promotion of women's health should be addressed and promoted at every visit. The most fundamental elements of preconception care that can impact a healthy pregnancy include screening for medical, behavioral and social risk factors, followed by appropriate clinical and education interventions.
Preconception Screening – At the Forefront
HFS partnered with eQHealth Solutions to develop a preconception risk assessment tool and to establish preconception care guidance for HFS providers. Clinical studies indicate that preconception care targeted to high risk women can be effective when specific risk factors are identified and appropriate interventions are instituted.
The risk assessment tool was pilot tested in several provider practices. With significant contributions from eQHealth's physician panel members, as well as funding from the Michael Reese Health Trust, a validated standardized, two-page risk assessment tool for preconception care was developed. The tool establishes the key tenets of preconception health, and is pertinent for screening, risk assessment and intervention, and allows for easy incorporation into a standard medical record. For further information on available resources for providers, see the Resources section in this Notice.
Support of Proactive Care
As part of their study, eQHealth Solutions notes that an essential component of preconception care is the consistent question of pregnancy intent by healthcare providers. Since women often seek care from multiple providers, it is critical that each visit be viewed as an opportunity to discuss preconception health. When routinely practiced, this patient interaction and education can lead to improved outcomes.
HFS' Preconception Risk Assessment & Clinical Guidance Tool Form HFS 27 (pdf) is available on the HFS Web site, Medical Programs Forms page. Providers can either download and print the form or use the electronic fillable PDF format to enter information at their computer and then print. To order a supply of HFS Form 27, please go to Medical Programs Forms Request.
HFS' validated Preconception Risk Assessment Tool is the preferred tool; however, other risk assessment tools may be used. Risk assessments must be formally validated, nationally distributed by a recognized organization, and individually administered. The provider must obtain written approval from HFS prior to using other preconception risk assessment tools.
To receive reimbursement for administering the risk assessment, providers must use CPT code 99420 – Administration and Interpretation of Health Risk Assessment Instrument. The current reimbursement rate is $14.60.
Consultation and Referral Services
Healthcare providers who provide services during the preconception and interconception periods should assess women for medical and psychological risks and provide referrals for appropriate treatment and counseling.
In addition to obtaining the preconception risk assessment and clinical guidance tool on HFS' Web site, providers can find additional information on preconception care at the following:
For questions related to this notice, please contact the Bureau of Maternal and Child Health Promotion at 217-557-5438. For billing related questions, please contact the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs